PFI2018-00233 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
Is COMMUNITY DEVELOPMENT Permit#: PF12018-00233
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 09/05/2018
Parcel: SEG806
Jurisdiction: Tigard
Site address:
Subdivision: Lot:
Project: PGE
Project Description: Replace pole. PGE Job M2486124.
Owner: FEES
Description Date Amount
PHONE:
Contractor:
PHONE:
FAX:
Applicant:
SHANEA HARDCASTLE
10800 SW AVERY ST
TUALATIN, OR 97062
PHONE: 503-464-7777
Total $0.00
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee/Applicant
Signature:
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00233
Type: Condition Name: Status: Severity:
PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Utilities 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. The
spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited
and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up
and suspension of work to accomplish clean-up.
PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Utilities 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be
reinstalled or replaced,with like kind of material. Obtain City approval of restoration work.
PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services
Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area. Traffic control devices, flag persons, etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services: 503-629-0111 (Tigard Police Dept.,Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met)
and 503-431-2345(Tigard School District)and other service providers impacted by such closure.
PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice
Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City
approval of any access closures.
PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice
Work is permitted in daylight between the hours of 7:00 a.m. to 7:00 p.m. Mon-Fri unless otherwise authorized by the City.
PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit
holder's expense.
PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice
Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole
before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at
the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI_Utilities 14-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads,ditches, etc.)as may be necessary, as determined by
the Inspector,to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert
Phone#>,to establish a preconstruction meeting.
PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector twenty-four(24) hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit.
PFI_Utilities 18-PERMIT/PLAN ON SITE Applied Notice
A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan
and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and
provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and
specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work
performance.
PFI_Utilities 19-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice
Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have
authority to resolve problems, take corrective action and, in general, will be responsible in case of any emergency. The
applicant shall notify the City Inspector, in writing, of any/all assignment changes.
PFI_Utilities 21 -OTHER Applied Notice
"ECEIVED
City of Tigard SEP 0 4 2018
PUBLIC WORKS —ENGINEERING
ITE' I T i CARD
Public FacihtyImprovement (PPrF' 1A,P, -� 1 it
TYPE OF WORD
DESCRIPTION OF WORK(in the right-of-way)
TYPE 1—Franchise Utility Work
Check one: V Utilities ❑ Sidewalk/driveway approach ❑ Street improvements performed by NWN, PGE
p
Detailed description: Replace lace ole and/or utility agency.
❑ TYPE 2—Sidewalk/Driveway/Sewer
Work performed for the purpose of:
PGE Job M2486124 • Sidewalk installation or repair.
• Driveway approach installation
12790 SW Katherine St %
Property address/location(s): V" and/or repair
Tigard, OR 97223 • Sanitary sewer lateral installation
and/or main line tap
PGE Submitted b Shanea Hardeastle ❑ TYPE 3—Full scale Development
Applicant: I Y � Work performed with Land use
Address: 10800 SW Avery St approval which includes any of
City/state: Tualatin, OR 97062 Zip: the following:
Phone: 503-464-7777 Email: preregcoord@pgn.com • Subdivisions or Partitions
Contact name: Phone: • Street widening
• Mainline installation for Sanitary
Contractor: Portland General Electric sewer, Storm sewer, Tigard water
and/or Tigard Water Service Area
CCB#: 103663 Expiration:
Address: SUBMIT COMPLETED APPLICATION TO: '
City/state: Zip: City of Tigard
Planning/Engineering
Phone: Email: 13125 SW Hall Blvd.
Contact name: Phone: Tigard,OR 97223
Applications for"minor work in right-of-way"
only may be emailed to:
Engineer: rowpermitsktigard-or.gov
Address:
FOR STAFF USE ()NI-Y
City/state: Zip:
Phone: Email: Case No.-
Contact
o.Contact name: Application submittal fee.(.007'P/,of
Engineer'.s.Esti.mate) $ 40
Estimated value of work is required(if over$5,000):$ Additional fees: $
(within the public right-of-way) Application.accepted:
By: Date: 91.1-1h
Is work related to a LAND-USE DECISION? ❑ Yes No
pplicatiori reviewed:
If so, please specify (MLP,SDR, SUB,etc.) case #:
By: Date:
Is work related to a BUILDING PERMIT? ❑ Yes No Applicant notified:
If so,please specify(BUILDING PERMIT)case#: By: Date:
I:\ENG\PermitApplications\pfi_application Rev.10/16/2017
City ofTigard 13125 SW Hall Blvd. Tigard,Oregon 97223 www.tigard-or.gov 503-718-2421 Page 1 of4
APPLICAN'T'S
NOTE: Person specified as "Applicant"shall be designated"Permittee"and shall provide financial assurance for work,if
required by the city pursuant to TMC 15.041.140.
* With the exception of a utility operating pursuant to a valid franchise with the City of Tigard,when the owner and the applicant are different
people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the
owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. Franchised
Utilities are not required to obtain the owner's signature on the application
BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT:
• The above request does not violate any recorded deed restrictions that may be attached to or imposed upon the subject
prol2eriy-
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements in any plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application.
Kevin D Mi irk 9d4.118
Applicant/Authorized Agent's signature Print name Date
SIGNATURES of each owner of the subject property, if required.
Owner's signature Print name Date
Owner's signature Print name Date
}
Owner's signature Print name Date
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 2 of4
DEVELOPMENT ENGINEERING FEES FOR
Public Facility Improvemetnt(PFI)Permit:
DETAILED
APPLICATION FEE REQUIREMENTS
Part 1: Required submittal fee$300.00 (minimum) FRANCHISE UTILITY AND SIDEWALK/
DRIVEWAY AND UTILITY
PERMIT FEE CONNECTIONS,ETC.
Part 2: All non-water system improvements (work in the right of way)
Engineer's estimate X 5%(less$300.00 minimum
submittal fee) Sketch
Engineer's estimate X 2%Plan Review (including information below)
❑ Dimensions
WATER SYSTEM FEE Street Name
Part 3: All public water system improvements El. Site Address
Engineer's estimate X 12%
FULL SCALE DEVELOPMENT
PFI Permit Fee Exemptions: (Subdivisions/Partitions and Street Improvements)
There will be no permit fee charged,or assurance required
for the following types of work: Design Plans
• Sidewalk repair(less than 20 lineal feet) (6 sets;24x36 or.22x34)
• Relocate or replace mailbox ❑ Cover*—Site,Vicinity,abbreviation,Legend
• Ditch cleaning that does not involve regrading. ❑ General Notes (City,Water,Sewer,etc.)
• Weep hole repair ❑ Street(Plan,Profile)
• Curb repair or replacement(less than 20 lineal feet) El, Water,Storm and Sanitary(Plan Profile).
• Lawn sprinkler system installation or repair ❑ Water Quality Facilities
• Street tree pruning or planting 0 Grading
• Planter strip landscape maintenance ❑ La.n_dscapir g/Tree Plan
• Test wells El Com Utility Plan(Electrical,Phone,,Gas,,
Storm,Sanitary,Water,Signage,Street Lights;etc)
❑ Details.
Note: A cash/bond assurance maybe ❑ Traffic Sight Distance
required per TMC 15.04.140. El Signing and Striping
(customer deposit) ❑ Street Light Plan and Photometric
❑ Engineers seal/signature
❑ Sheet label(project land use name,revision and
plan log block,dates and sheet numbers.)
Additional Submittals
(per Land Use conditions)
Q Traffic Report
Storm water Drainage Calculations
❑ .Geotechnical Report
Preliminary Access Report.(Sight Distance)
Q Proposed Plat-
El Pathway Design(if applicable)
❑ Water Department Approval
❑ Engineer's Construction Estimate
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of
SAMPLE SKETCH:
Edge.of Pavement
0
y8 } } I ® Ditch
I
T-Fr- s t ewer 11Il e
II �n� I :Extst�ing,llous:e"' 1
® I Existing>1 Drive'way
1.
�I I
31
a up
G 1 ■-a � e .. -
O: r.
a
WI
ON
13
�.
1 "Eiisti n1glS,h o.pY�
H J
Powerpole
Imo. 95. �.
°--------7rapertjGne-------®---
° Fire Hydrant(FH)
Scale: 'I"=30'
a
I I °
I �
I I °
I � I
MINIMUM SKETCH REQUIREMENTS (Put"N/A"if Not Applicable):
North arrow Property lines & dimension Slope of property
Street &street name(s) Existing building, structures Utility&street light poles
Proposed work Existing curb or edge Trees
Existing S/W or of pavement Existing utility locations
D/W apron (sewer,water,storm)
PUBLIC FACILITY IMPROVEMENT PERMIT
City ofTigarcl • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 4 of4
Z C11-33a
r
`'� LIGHTING LEGEND
d
'i � - �;g�F
6 _ INSTALL 1004VHPS TOWN&COUNTRY LIGHT
20'-Unknavm —..�- � � 119= ON 20'13LACKRBERGLASS POLE
2007 CONNECTATMV
80610
9
90 4 N,
20'
148 Open SW.KATHERINJt ST ` f
` 2AL
C~�C2A1
c j SOE12 8060$x'
2C-1 POLE 80612,ASSET 93890 �,
C.60 23664 PD-8117 19 TE BAD ORDER POLE HAS BEEN 10
ap REMOVED.INSTALL NEW 20',2
�, 1 PIECE BLACK FG POLE>f 100W NPS 776
TBC.
ATTENTION: CALL 811 BEFORE YOU DIG
OREGON LAW REQUIRES YOU TO FOLLOW RULES ADOPTED ,
BY THE OREGON UTILITY NOTIFICATION CENTER. ,
THOSE RULES ARE SET FORTH IN OAR 952-001-0010
THROUGH 952-001-0090.YOU MAY OBTAIN COPIES OF
THE RULES BY CALLING THE OREGON UTILITY
- NOTIFICATION CENTER ADMINISTRATION @ (503-232-1987)
TO REQUEST UTILITY LOCATES CALL THE OREGON Know whaYS below.
UTILITY NOTIFICATION CENTER,811 AT LEAST Call before you 2 6USINore
FS$PAYS PRIOR TO EYCAVATION Y dl9•
PGE CONSTRUCTION DRAWING
SDPANENG REVIEW: JASBUILT BY DESIGNER:
AS-BUILT VERIFICATION & NESC VIOLATIONS CORRECTED
This document occurately represents FIELD construction.
Foreman: Date:
GF: Date:
DATE: 311118 SCALE: WA ACCOUNT: 1070001 AWO: 1000004600 JOB NO.M2486124
TITLE CITY OF TIGARD/BAD ORDER POLE
CIRCUIT TIGARD-13362 SIZE
PGE 1 1x17
LOCATION 12790 SW KATHERINE
THINK ` DESCRIPTION REPLACE B/O SLO POLE WITH 20'2-PIECE FBRGLS PL&10OW
HPS T&C FIXTURE.CONNECT AT 240V.
SAFETY COUNTY SECTION(S) WORK WITH SHEET
BEAVERTON WASHINGTON C2104A NA ) OF I
FIRST! LINE CREW CENTER DESIGN BY PHONE(503) DRAWN BY
2213 SW 153RD DR CHELSIE KEARN 672-5545 CHELSIE KEARN
BEAVERTON.OR 97006 0 PORTLAND GENERAL ELECTRIC CO.-ALL RIGHTS RESERVED
Page 118 2011 Edition
Laine CI®$%%'rebat Ir�tersecto®c `v�ith Fla I, Dagrar �' 2®
Diagram 620 covers work within an intersection when normal traffic control
must be interrupted. Work vehicles may or may not be in the work space.
1. During flagging, traffic signals shall be turned off. Contact the road
jurisdiction for approval and assistance(see Chapter 3).
2. For multi-lane facilities, traffic approaching the intersection shall be
reduced to a single lane on each approach. See Chapter 3 for
information on flagging through intersections.
3. There should be one flagger for each approach. One flagger may
control two adjacent approaches if sight distance, low volumes on side
roads, and flagger position allows for safe operation and clear direction
to motorists. For low traffic volume intersections(fewer than 400
entering vehicles per day), one flagger may be used.
4. The"ONE LANE ROAD AHEAD" (W20-4) sign is optional and should
be considered on high volume or high speed roads, or when extended
queues may be expected.
Sign Spacing and Buffer Lengths(feet)
Posted° Spacm BetweenSigns `Buffer.
'Seed
_.P �► 8, ' 4C y Space.
20 50
25 100 100 100 75
30 100
35 40 350 350 350 125
150
45 180
50L_J 500 500 500 210
55 250
Chapter 5 December 2011
2011 Edition Page 119
.Lane. gsure.at Irotersectio we, Flagging Diagram 620
ROAD
WORK
AHEAD
>lc
ROAD
AHEAD
BE
B
PREP
1n
B
A (OPUOW
Rano
1008 Max. •
PRE WORK
ROAD
• TO STOP WORK
� AHEAD
A B B C
Buffer ® •�c
o ® '
Llano
I
100 R Max.
C B B A
ROAD B
WORK PREPARED •
AHEAD loot
Max
KM � •• 1
A
B
BE
PREPARED
TO sTOP
B (00-4
E
1 4 AHEAD
ROAD
WORK
AHEAD
December 2011 Chapter 5